Original article
Adult cardiac
High-Dose Tranexamic Acid Is an Independent Predictor of Early Seizure After Cardiopulmonary Bypass

Presented at the Poster Session of the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.07.085Get rights and content

Background

Risk factors associated with early seizure after cardiopulmonary bypass (CPB) were examined. The role of tranexamic acid in seizure development was evaluated.

Methods

Early seizure was defined as a seizure occurring within 24 hours of CPB, without neurologic deficit or new lesion on brain imaging. Independent determinants of early seizure were examined by multivariate logistic regression modelling.

Results

Between 2004 and 2009, early seizure occurred in 119 of 8,929 patients (1.3%). A significant increase in the yearly rate of early seizure was observed in 2004 (0.73%) vs 2009 (1.97%; p < 0.0001). Multivariate analysis showed the following variables were independent predictors of early seizure: age older than 75 years (adjusted odds ratio [OR], 2.1; p = 0.0001), open heart procedure (OR, 12.0; p < 0.0001), preoperative renal failure (OR, 3.2; p < 0.0001), peripheral vascular disease (OR, 1.8; p = 0.02), and total tranexamic acid dose of 100 mg/kg or more (OR, 2.6; p < 0.0001). Risk of seizure was related to tranexamic acid in a dose-dependent fashion, with higher doses associated with increased risk of seizure. The use of CO2 in a subset of patients undergoing open heart procedures did not decrease the incidence of early seizure (4.8% vs 2.5% for no CO2; p = 0.27). Postoperative chest tube drainage and blood product use were similar between patients receiving low-dose and high-dose tranexamic acid.

Conclusions

High-dose tranexamic acid (≥ 100 mg/kg) is independently associated with an increased risk of early seizure. Future tranexamic acid trials should assess the blood-conserving effect of tranexamic acid at a lower dosage and specifically monitor for seizure occurrence.

Section snippets

Patients and Methods

The study protocol was in accordance with our local Institutional Research Ethics Board and received full approval.

Incidence of Early Seizure

Between 2004 and 2009, 8,929 patients underwent CPB through a midline sternotomy for CABG, replacement of the thoracic aorta, or a procedure involving entry into a left-sided cardiac chamber at the Quebec Heart and Lung Institute. Isolated CABG was performed in 5,510 patients (61.7%). Perioperative tranexamic acid was used in 8,082 patients (90.5%). Low-dose tranexamic acid (total dose < 100 mg/kg; range, 25 to 99.9; mean 59 ± 17.6) was used in 6,328 patients, and high-dose tranexamic acid

Comment

This study documented early seizure in 119 of 8,929 patients (1.3%) undergoing CPB, nearly 90% of whom were undergoing operations involving left-sided cardiac chamber entry or aortic operations, or both, with the remaining 10% occurring in isolated CABG patients. Early seizure was associated with renal failure, prolonged intubation, and increased hospital resource utilization, effects that persisted after multivariate risk-adjustment using propensity scores. In addition to advanced age,

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